Facing Many More Demands, P&T Committees Seek Expertise

Those who are quick to disparage management by committee probably would be just as quick to disparage management by despotism, if they weren't so frightened of the despots. American entrepreneurial spirit has seeped into the most formal of businesses to facilitate a free flow of ideas. Or at least that's the aim.

Contributing Editor MargaretAnn Cross's cover story shows how health care is as attracted to the possibility of mining expertise as any other industry. Her article demonstrates how the formulary committee has been opened up to admit more than just those players who are still the recognized mainstays of those bodies — physicians, medical directors, pharmacists. Specialists, nurses, and PBM personnel are now coming aboard. Epidemiologists, statisticians, and actuaries aren't far behind. The chart reveals a whole category called "other."

Thanks to a rash of new agents flooding the market — and set against a backdrop of increasing public attention focused on access and out-of-pocket costs — P&T committees are expected to do more, review more, and take more into consideration when making decisions. As a result, they have been forced to go after experts they may not have needed in the past, and in the near future may have to go even further, tapping geneticists and ethicists to unravel the complications that genetic medicine will introduce.

What comes out of such committees is so vital that HMO physician executives seek extra training on the best ways to run such meetings, a point made by Alan G. Adler, MD, MS, the interim chief medical officer at Horizon Mercy, a Medicaid HMO in New Jersey. His first-person account about being coached in executive skills is all about listening. Ditto for our Q&A feature, in which Bob Stone, a DM lifer, explains how that niche industry has listened to what customers want and is evolving as a result.

Change is vital, even if it doesn't come easily. Yet not all change is desirable. Near the back of this issue, our thoughtful ethicist, Michael Victoroff, MD, discusses the utility of full body scans, and finds some reasons not to embrace the new.

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Managed Care's Prospects in the Health Reform Era

Princeton’s Uwe Reinhardt, PhD, renowned health care economist, sits down with Managing Editor Frank Diamond to discuss the economic effects of the Affordable Care Act, wellness programs, and the state of health care in the United States in general.